Global fund to fight AIDS, Tuberculosis and malaria (GFATM) is one of the global funding mechanisms to support scale-up of HIV prevention, treatment, care and support services in low and medium income countries of the world. Nigeria is one of the countries whose application for grant to the Global fund round 9 was successful. This resulted in the consolidation of Rounds 5 and 9 into a single grant. The consolidated Round 9 Grant will be implemented in 2 phases over a period of 5 years. The phase one commenced on 1st July 2010.
Based on the 2008 HIV prevalence rate, NACA (2009) estimates that about 2.95 million people are living with HIV in Nigeria (Male-1.23 million: Female-1.72 million). Of this figure 833, 000 adults and children require antiretroviral (ARV) drugs. Towards achieving universal access targets and MDG goals, the GFATM R9 seeks to address HIV prevention, treatment, and care and support gaps in the national response.
Association for Reproductive and Family Health (ARFH) was selected as one of the 3 Principal Recipients (PRs) to execute the phase 2 of the GF R9 grant. Similarly, ARFH selected the Network of People living with HIV and AIDS in Nigeria (NEPWHAN) as one of its Sub-Recipients (SRs) to implement activities of the Global fund round 9 phase 2 project.
NEPWHAN will be working to identify 10 support groups and engage 40 Treatment Adherence Supporters who are competent and qualified to be engaged in implementation of the Phase 2 project till 2015 in each of the following states; 1) Abia, 2) Akwa-Ibom, 3) Anambra, 4) Bayelsa, 5) Borno, 6) Cross Rivers, 7) Delta, 8) Ebonyi, 9) Edo, 10) Enugu, 11) FCT, 12) Kogi, 13) Lagos, 14) Nasarawa, 15) Rivers and 16) Taraba.
These States selected above are part of the 20 + 1 most burden HIV/AIDS states in Nigeria.
The network is working on objective 3: To scale-up gender sensitive care and support for People Living with HIV/AIDS (PLWHAs) and Orphans and Vulnerable Children (OVC) with focused on SDA 11: Basic Care and support for chronically ill, HBC/adherence support
The Program Goal is ''To scale-up gender-sensitive HIV/AIDS prevention, treatment, and care and support interventions for adults and children in Nigeria and to contribute to the restoration of public confidence in primary health care services in Nigeria, and thereby reverse declines in the utilization of primary health care facilities.''
HIV related stigma and discrimination is widely recognised as a barrier to accessing HIV prevention, treatment and care services, yet little is known about the extent of this problem in Nigeria. This study aimed to rectify this through documenting the various experiences of HIV related stigma and Discrimination against people living with HIV and, in doing so, contributes to strengthening the evidence base for advocacy, policy change and programmatic interventions.
Positive Health, Dignity and Prevention (PHDP) is a policy and advocacy framework that recommends addressing the human rights, health and welfare needs of PLHIV holistically as a critical step to more effectively engage them. In fact, a focus on the health and dignity of people living with HIV also contributes to the health and wellbeing of their partners, families and communities, and in and of itself, should act as significant steps towards HIV prevention.
PHDP is a distinct shift from ‘prevention with positives’ (PwP) projects being rolled out in a number of countries, including Nigeria, which are narrowly targeted at changing the behaviour of people who know that they are HIV-positive, with limited consideration of how failure to meet their needs for social support, human rights and treatment of PLHIV can undermine HIV treatment and prevention efforts. PHDP calls for programmes to recognise the value of PLHIV as partners, leaders and implementers of the HIV response, including HIV prevention. Programmes should empower and build the capacity of PLHIV and not simply treat them as patients, passive targets or worse, as vectors of transmission. PLHIV should be seen, not as part of the problem, but as an integral part of the solution. PHDP argues that in order to reach and engage PLHIV in the HIV response, national programmes must address the following points:
1. Establish a legal and policy environment where it is safe to live openly as an HIV-positive person (if he or she so chooses), free from the fear of HIV stigma, discrimination, gender violence, displacement or other human rights violations;
2. Focus on the health and well-being of PLHIV by providing universal and convenient access to essential treatment, care and support services including confidential HIV counselling and testing services. A focus on high quality health services is needed to improve and maintain the well-being of those who test HIV-positive, including timely anti-retroviral therapy (ART);
3. Provide the tools and services to enable HIV-positive people to exercise their full sexual and reproductive health rights, while protecting their partners and infants from HIV;
4. Develop policies and support services addressing the social and economic factors that undermine the health and dignity of PLHIV such as poverty, food insecurity, and lack of access to educational opportunities or employment, gender inequality and the discrimination and oppression of key marginalised populations at risk of HIV (including men who have sex with men, people who use drugs, migrants, prisoners, young people, women and sex workers);
5. Tailor non-judgmental services to reach out to the underserved key populations.
HIV prevention services need to include PLHIV, including key populations, in conception, design and implementation of the services targeting them. Otherwise, programmes may fail to consider critical fears or needs of the population and may even stigmatise their targeted population and limit the uptake and effect of the service. For instance, prevention initiatives focused solely on the responsibility of PLHIV to prevent passing on HIV to others, may inadvertently send out the message that ‘PLHIV are solely responsible for HIV transmission’ and lend support to efforts to criminalise HIV-exposure and/or transmission and ‘scape-goat’ key populations. Such an approach can backfire and actually increase the transmission of HIV by chasing the targeted population groups away from HIV testing and health services. HIV treatment and prevention interventions will never achieve their optimal desired results in an environment where the human rights of PLHIV are not respected or where their social and health needs are not being met, and when they are not engaged in the services that affect them.
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